Howard Dean: Please Fund Obamacare, Even Though It Can't Work

In an op-ed in Monday's Wall Street Journal, former Democratic presidential candidate and Vermont Gov. Howard Dean argues that Obamacare's main cost-control mechanism, the Independent Payments Advisory Board (IPAB), will not work. Nevertheless, he says, Congress should reject attempts to defund Obamacare.

The IPAB is fundamental to the design of Obamacare, rivaling the individual mandate in importance. It would consist of fifteen experts with final authority to decide what treatments public insurance will cover. Former Office of Management and Budget director Peter Orszag, who championed the IPAB, said in 2010 that it has "an enormous amount of potential power" to control health-care costs in Medicare and Medicaid:

...this is a very substantial change. Statutory power to put forward proposals to reduce health care cost growth over time, and improve quality, and those proposals take effect automatically if Congress ignores them, if Congress votes them down and the President vetoes that bill. 

Orszag also described the IPAB as critical in moving the U.S. health care system away from fee-for-service and towards prioritizing quality.

Former Alaska Gov. Sarah Palin described the IPAB as a "death panel" because of its ability to ration care. Dean's objection to the IPAB is, in essence, the same: "The IPAB is essentially a health-care rationing body," he writes in the Journal. "By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them."

Citing his own experience in Vermont, Dean--who is also a physician--recounts the main objection to independent cost-control panels: "patients and physicians get aggravated because bureaucrats in either the private or public sector are making medical decisions without knowing the patients." That aggravation, he argues, does not actually produce cost control. In fact, he says, further bureaucracy drives costs upwards. 

There is "no possibility," he says, that the IPAB will fulfill Orszag's goal of moving away form fee-for-servive.

And yet, Dean argues, Congress must still fund Obamacare and see it implemented as fully as possible. He joins those who call conservative proposals to defund the law the "dumbest idea I've ever heard." But given that there is no legislative effort by Democrats to drop the IPAB from Obamacare--certainly none that would win President Barack Obama's support--Dean may have to take his medicine. And pay for it.


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